Canadian Prime Minister Justin Trudeau and Global Fund Executive Director Mark Dybul at the opening of the second day of the fund’s fifth replenishment conference in Montréal, Canada. Photo by: The Global Fund / Vadim Daniel

The Global Fund to Fight AIDS, Tuberculosis and Malaria hit its funding goal at the fifth replenishment conference in Montreal, Canada, on Sept 16-17. But advocates warn that those funds may still fall short of what’s needed to reach the most vulnerable communities.

The reasons include persistent human rights challenges and access to affordable drugs — both of which require new financing and better policy, advocates said.

Speakers called for global health organizations to intensify their efforts with marginalized groups and key populations such as LGBT, sex workers and drug users. “In order for us to end these epidemics, we have to respond as human beings to not only accept, but to embrace the dignity and worth of every human life, no matter who they are or where they are,” said Global Fund’s Executive Director Mark Dybul.

Access to new healthcare innovations also took center stage. The U.N.High-Level Panel on Access to Medicines report published on the eve of the replenishment described what it called a “misalignment between the right to health on the one hand and intellectual property and trade” and called for “bold new action” in boosting research and development. The report calls for countries to better utilize flexibilities in the global Trade-Related Aspects of Intellectual Property Rights agreement to facilitate generic drug production.

“We fully support increasing access and lowering drug prices, but there is not a simple answer to intellectual property rights, the Global Fund’s head of communications Seth Faison told Devex in an interview. “We support generic companies very strongly, we support originator pharmaceutical corporations very strongly. Whatever combination can increase access and lower prices, that's what we need to support.”

New donors, bigger donations

The replenishment raised $12.9 billion from public and private donors, falling just $100 million short of its fundraising target.

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The United States remains the largest contributor to the Global Fund, with a $4.3 billion pledge, up 7 percent from the previous funding cycle. The United Kingdom followed with a $1.43 billion contribution tied to a performance agreement that will see 10 percent of the funds paid out on condition of results. Germany increased its pledge by 33 percent, with a $893 million contribution. Japan pledged $800 million (a 46 percent increase), and the European Commission pledged $525 million (a 30 percent increase).

New donors including Qatar ($10 million), Benin ($2 million) or Togo ($1 million) pledged for the first time to the Global Fund. The Bill & Melinda Gates Foundation increased its pledge by $100 million, reaching $600 million, while contributions from the private sector and innovative financing mechanisms more than doubled to $250 million.

Money worries

Despite the strong pledges, the Global Fund still needs an additional $20 billion to meet its overall needs over the next three years. The December preparatory meeting for the replenishment conference in Tokyo budgeted $97 billion — $64 billion are expected to be covered by domestic resources and international sources outside the Global Fund.

“We set a goal of $13 billion because we felt it was both ambitious and realistic,” Global Fund’s Faison told Devex. “But we agree this is a floor, not a ceiling, and this replenishment conference is really the beginning of a three-year replenishment period, and we will be continuing to raise money through that period.”

Civil society members who spoke with Devex indicated that the funding shortages are more dire than they appear from the headline numbers. Funding to combat HIV/AIDS for example has been falling for the last half-decade as donors move on to other causes.

“There is increasingly an AIDS funding crisis in the world,” Matthew Kavanagh, senior policy analyst at Health Gap — an organization of AIDS and human rights activists working to eliminate barriers to global access to life-sustaining medicines for people living with HIV/AIDS* — told Devex. For example, the scale up of antiretroviral therapy, which is necessary to reach UNAIDS’ Fast-Track targets, won’t be able to continue at the same pace unless more funding is secured, he warned.

Donor fatigue is also affecting malaria and TB, warned Lucica Ditiu, executive director of the Stop TB Partnership. “We run on very small budgets at Stop TB. But when you approach a donor, the answer that you get is, ‘but we gave to the Global Fund for TB, and we increased [our funding] even,’” she told Devex.

Poor timing

Potential funding shortfalls come at a time when a growing number of middle-income countries are transitioning off of support from the Global Fund. Thirty-two country components (eligibility is classified per country and disease) became ineligible for funding when the Global Fund’s new funding model came into effect in 2014. Additional changes brought to the fund’s Eligibility Policy earlier this year may further impact which countries can receive grants.

Ditiu of Stop TB said that technical and budgetary support to help these countries is limited. She experiences this first hand with her organization, which helps build the capacity of local governments to tackle TB. A good response begins with institutional shifts, such as “having a budget line called ‘TB drugs,’” she said. “Unfortunately the funding for groups such as Stop TB, at least for us, is very limited or very reduced for these kinds of efforts.”

Others voiced concerns about the ability of transitioning and middle-income countries to support civil society groups’ work on prevention, treatment and advocacy. In certain settings, community groups are the only ones working with marginalized and key populations, yet they often lack government recognition or the necessary resources to apply for funding, said Mike Podmore, director of STOPAIDS, a network of U.K.-based international NGOs working on the global HIV response. Efforts to build the capacity of grassroots organizations and ease the burden of reporting for funds are crucially needed, he added.

Where will it come from?

“Coming out of this conference,” Kavanagh of Healthgap told Devex, “One of the core questions is, Where is the rest of the money going to come from?”

Large donors countries are unlikely to fill the gap, as Devex reported in July. The Global Fund’s Faison said the organization couldn’t ask large donors such as the United States and France to contribute more than they already have.

Asked how the Global Fund would help channel its funds to community groups, Faison answered: “We won't be able to fund everybody, but we honestly do our best with independent evaluators to choose which programs can be most effective.”

* Update, September 20, 2016: The description of Health GAP has been updated in this article.

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About the author

  • Flavie Halais

    Flavie Halais is a freelance journalist based in Montreal, Canada, covering international issues and cities through a social lens. Her work has appeared in WIRED, the Guardian, Le Monde Afrique, Jeune Afrique, the Correspondent ,and Devex.